The Stabilising Effect of the Anterior Oblique Ligament to Prevent Directional Subluxation at the Trapeziometacarpal Joint of the Thumb: A Biomechanical Cadaveric Study | ||
The Archives of Bone and Joint Surgery | ||
مقاله 4، دوره 6، شماره 2، خرداد 2018، صفحه 105-111 اصل مقاله (973.11 K) | ||
نوع مقاله: RESEARCH PAPER | ||
شناسه دیجیتال (DOI): 10.22038/abjs.2017.20758.1557 | ||
نویسندگان | ||
Mark R. McCann* 1؛ Philippa A. Rust2؛ Robert Wallace3 | ||
1Department of Anatomy, Edinburgh University Medical School, UK | ||
2Hand Surgery Unit, St John’s Hospital, Livingston, UK | ||
3Department of Orthopaedics, University of Edinburgh, UK | ||
چکیده | ||
Background: The trapeziometacarpal joint (TMCJ) is inherently unstable, relying on ligament restraint to prevent subluxation. Subluxation of the thumb in a dorsoradial direction is often observed in clinical practice, either after acute ligament injury or more commonly with osteoarthritis (OA). This subluxation follows loss of function of trapeziometacarpal ligaments that stabilise this joint, resisting the deforming force of abductor pollicis longus (APL). The exact ligaments that stabilise and prevent the thumb from the pull of APL causing dorsoradial subluxation remain unknown, although the anterior oblique ligament (AOL) has been implicated. The aim of this study was to measure the direction of subluxation resisted by the AOL. Methods: In this study we used cadaveric limbs and custom made biomechanical testing to measure the influence AOL has in stabilising the thumb against subluxation in three planes: radial, dorsal and dorsoradial. Three fresh frozen hands were dissected to expose the TMCJ, leaving all ligaments, capsule and APL attachment in place. The force required to create a displacement of 5mm between the first metacarpal and the trapezium in these three planes was measured before and after AOL division. Results: The average force to displace in the dorsoradial plane prior to division was 6.68N, and a statistically significant reduction to 1.15N (P<0.001) was found after division of the AOL. A statistically significant increase in force (P<0.001) from 2.89N to 4.04N was seen in the radial plane, while no change was seen dorsally (P=0.98), with average forces of 2.74N and 2.62N found pre and post division. Conclusion: There is clinical significance in reporting quantifiable data in this field, as subluxation of the thumb is often seen with OA. The results of our study provide support for surgical reconstruction of the AOL as the primary surgical stabilizer against dorsoradial subluxation of the thumb. | ||
کلیدواژهها | ||
Anterior oblique ligament؛ Biomechanical testing؛ Thumb؛ Trapeziometacarpal joint؛ Stability؛ Subluxation | ||
مراجع | ||
1. Brunelli GR. Stability of the first carpometacarpal joint. In: Brüser P, Gilbert A, editors. Finger bone and joint injuries. Abingdon: Taylor & Francis; 1999. P. 167-70. 2. Gander B, Wollstein R. Surgical treatment for thumb CMC joint arthritis. Curr Rheumatol Rev. 2013; 9(2):113-8. 3. Halilaj E, Rainbow MJ, Moore DC, Laidlaw DH, Weiss AP, Ladd AL, et al. In vivo recruitment patterns in the anterior oblique and dorsoradial ligaments of the first carpometacarpal joint. J Biomech. 2015; 48(10):1893-8. 4. D’Agostino P, Kerkhof FD, Shahabpour M, Moermans JP, Stockmans F, Vereecke EE . Comparison of the anatomical dimensions and mechanical properties of the dorsoradial and anterior oblique ligaments of the trapeziometacarpal joint. J Hand Surg Am. 2014; 39(6): 1098-107. 5. Bettinger PC, Berger RA. Functional ligamentous anatomy of the trapezium and trapeziometacarpal joint (gross and arthroscopic). Hand Clin. 2001; 17(2):151-68. 6. Van Brenk B, Richards RR, Mackay MB, Boynton EL. A biomechanical assessment of ligaments preventing dorsoradial subluxation of the trapeziometacarpal joint. J Hand Surg Am. 1998; 23(4):607-11. 7. Colman M, Mass DP, Draganich, LF. Effects of the deep anterior oblique and dorsoradial ligaments on trapeziometacarpal joint stability. J Hand Surg Am. 2007; 32(3):310-7. 8. Neumann DA, Bielefeld T. The carpometacarpal joint of the thumb: stability: deformity and therapeutic intervention. J Orthop Sports Phys Ther. 2003; 33(7):386-99. 9. Park MJ, Lichtman G, Christian JB, Weintraub J, Chang J, Hentz VR, et al. Surgical treatment of thumb carpometacarpal joint arthritis: a single institution experience from 1995-2005. Hand (N Y). 2008; 3(4):304-10 10. Rust PA, Tham SK. Ligament reconstruction of the trapezial-metacarpal joint for early arthritis: a preliminary report. J Hand Surg Am. 2011; 36(11):1748-52. 11. Noyes FR, Torvik PJ, Hyde WB, DeLucas JL. Biomechanics of ligament failure. II. An analysis of immobilization, exercise, and reconditioning effects in primates. J Bone Joint Surg Am. 1974; 56(7):1406-18. 12. Najima H, Oberlin C, Alnot JY, Cadot B. Anatomical and biomechanical studies of the pathogenesis of trapeziometacarpal degenerative arthritis. J Hand Surg Br. 1997; 22(2):183-8. 13. Pellegrini VD Jr, Olcott CW, Hollenberg G. Contact patterns in the trapeziometacarpal joint: the role of the palmar beak ligament. J Hand Surg Am. 1993; 18(2):238-44. | ||
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